you're not losing a vagina, you're gaining a son

Category Archives: dr. baby factory

Gosh, internets, thank you for all the love and enthusiasm. Warms the cockles, I tell you what.

I keep thinking I’ll pull together the mental wherewithal to organize a proper post, but I’ve been spending all my wherewithal talking to insurance companies and billing offices. Herewith, the Insurance Items:

Background Item: Since the Bean was born, I have been on Sugar’s health insurance (Aetna, lifetime health cover loading), first because I wasn’t working and then because I wasn’t working in the right place to have my own. However, that insurance doesn’t have the kind of gold-plated fertility coverage I require, so this spring I accepted two night classes with a wretched commute in order to return to my old insurance (Empire Plan) long enough for an FET or two. This coverage ends in late August, at which point I will be back on Sugar’s plan.

Item: I screwed my courage but good and called the office of the nice OB — you know, the one who said four hours of pushing didn’t mean I wasn’t trying and used the word “horrified” more than once as I quivered on her exam table, trying to explain why coming in for a Pap smear had me so anxious. I like her a good deal and trust her about as much as I’m currently able to trust any member of her profession (midwives included, I’m afraid), and even so, I was quite dizzy with nerves as I waited on hold. (This bodes well for the coming months, eh?) I finally made it out of the holding tank and then through the nine million questions necessary to schedule early pregnancy appointments (knock wood, practice belief, knock wood), at which I point I casually mentioned that my insurance had changed since my last visit.

Guess who doesn’t take my current insurance, only six or so plans with remarkably similar names?

Cue panic attack.

After a lot of phone calls and mental math, I decided that the cost of seeing the good practice for a couple of out-of-network visits before returning to their accepted Aetna plan (three, I’m guessing) is lower than the cost of patching my mental health back together if I have to find a new practice, even just for a couple of months. I have a few hundred dollars of deductible to cover, after which my insurance will pay 80% of “reasonable and customary” charges; someone from billing is supposed to call me back this week, but she sounded like she thought they would likely work with me to charge amounts my insurance finds acceptable. This will still end up costing us quite a bit more than seeing someone in network, but therapy ain’t free, either. Especially at a time when I can’t avail myself of the kind sold in fifths of a gallon.

And anyway, that deductible has nearly take care of itself already, because…

Item: I am suddenly outside the bounds of my coverage at the Baby Factory, despite not being released as a patient yet.

My insurance considers the Baby Factory in-network for fertility care only, not for pregnancy care. This seems like no big deal, since the Baby Factory doesn’t do OB, but it did cause me some stress three years ago, when I started bleeding after they had released me but before I’d found an OB. At that point, Empire Plan considered a heartbeat on ultrasound as the boundary between fertility and obstetrics; I had a first beta, a second one week later, saw a heartbeat two weeks after that, and was sent on my way. It all seemed perfectly reasonable. We know too well that a positive first beta does not mean a Real Live Baby, but the rate of miscarriage drops significantly after a heartbeat.

Imagine my surprise, then, when having been relieved of yet another vial of blood this Sunday, I was handed a bill for the second beta (and progesterone and estradiol just for fun, I guess), to the tune of $300 and change. We can send it out to a lab your insurance pays for, said the lady in billing, but you won’t get results quickly. My cheapness fought my anxiety; cheapness is strong, but anxiety has throwing stars. So even though I had a sinking suspicion I wasn’t pregnant anymore, I decided to bet on good fortune and pay the bill, hoping that money would count against the deductible I’d spend at the OB’s anyway, assuming I got there.

So far, so good. Which brings us to…

Item: Ultrasound.

My father’s family has been going to this particular place on the shore of Lake Superior for a bit more than hundred years; there’s a gathering of cousins there planned for the end of June. We go there rarely, and I so want the Bean to see it. It is so beautiful, I won’t even pretend to do it justice in a rushed blog post except to say that it is what I picture when I think about heaven. And I’m not really a cold weather girl. It is also quite remote. The only telephone is several miles from where the cabins are; the nearest hospital certainly over an hour. It is sublime, but it would be a hell of a place to have an ectopic rupture.

I asked Dr. BF back in March what he thought of our going the on the heels of a May cycle. As long as your betas are unambiguous, he said. If they look potentially ectopic, I might have to tell you to stay home. Fair enough, I agreed. Just because this place is like heaven doesn’t mean I want to die there.

All this time, I’ve been refusing to quite believe that this trip will happen as planned, but the plan is to leave on Friday. (We are going to a wedding in DC, then to Sugar’s parents’ in lower Michigan, then to the UP, then home (Sugar) and Arkansas (the Bean and me, to see my mother). It’s quite the odyssey, even by our standards.) So after the first beta, I called Dr. BF to remind him of our deal, and that this means we will not be in town for their preferred viability ultrasound at something like 10 days past the second beta.

“You’re leaving Friday? Just come in Thursday morning for a scan. We won’t be able to see much, but as long as we can see something in your uterus, you can go.”

The first problem with this plan is the “Thursday” part. Thursday is Dr. Paternalistic’s shift. I do not want to get bad news from his mouth. I’m not even sure he’s capable of giving me good news without being an ass. But all my scheming about whether I could convince a babysitter to wait in a playground with the Bean (and our luggage?) so that I could go on Friday instead, on our way to the train (pause to appreciate the crazy scheme), was displaced on Sunday by fretting over the cost of the ultrasound without insurance. (Both, of course, a form of distraction from the more obvious anxieties attending such a scan.)

Happily, many phone calls later, it transpires that the prices of everything except the progesterone test are within the bounds of “reasonable and customary.” I confess shock that the blood tests are, frankly, and suspect this has less to do with chemistry than lab monopolies, but whatever, not my (immediate, individual) problem.

Item: The plan. Scan Thursday, very early so that Sugar can come before work. Probably too early to see a heartbeat, so we’ll try not to think about that part. I will see if I can sweet talk a nurse into jiggering the schedule so that we get the fellow I like instead of Dr. Paternalistic. If not, I guess I’ll live. On the other hand, this might be my last chance to kick him from the stirrups….

Item: this post is absurdly long. Sorry.

Item: I think that today I entered the part of pregnancy when I can’t have coffee anymore without feeling really sick. This lasted for the duration last time, and boy, is caffeine a more important part of my life with an early-rising toddler than it was pre-Bean.

Item: This morning also marked the first convincing nausea of this process (doxycycline excepted). Not so bad, as these things go, but still not my favorite.

Item: I’m not sure if this quite rises to the level of a craving yet, but holy Moses, is beef all I want to eat in the whole world. I could have wept for joy at the sight of hamburgers grilling at Sunday’s pool party.

Item: this post is absurdly unstructured. Sorry.

Item: I will leave you with some Bean cultural anthropology, inspired by his asking after the whereabouts of our local ice cream truck at six or seven on Saturday morning:

ME: Many people do not consider ice cream a breakfast food.

BEAN (thoughtful, serious): Maybe some do.

(And then, in the spirit of self-fulfilling prophecy, he fell backwards off a picnic bench while we were out to brunch with a friend, smacked his head on the concrete patio, acquiring in the process a magnificent goose egg and a free gelato from a sympathetic waiter. How is it so many people survive being toddlers?)

Sshhh, internets, the Bean is sleeping. Finally. I should be in the other room, using this time to finish my semester grading, but the Bean is also sick, and if I move, nap over. So how’s about some items, since I’m here for the foreseeable?

Item: for those following along at home, I was finally deemed worthy of triggering on Saturday. Transfer day is Friday. Cross your fingers, if you don’t mind, for an easy transfer and a conclusive beta to follow. Of course, I’d prefer a conclusively high beta, but what I’m most focused on at the moment is numbers that mean I get to go on our planned summer trip of friends and family and beautiful, quiet places in the north woods of Michigan. When I ran this idea past Dr. BF, he said it was all fine as long as they were satisfied nothing ectopic was happening. No one wants to risk a rupture that far from a hospital, not even me.

Item: There will be Valium at the transfer, and don’t think I haven’t made mention of that to every warm body I can find at the Baby Factory. (I know some clinics always use Valium — and I find their logic of reducing uterine contractions convincing — but mine doesn’t.) Look, I know things have changed in the down-there department, post-Bean, and it’s wholly reasonable to suspect at least one of those pesky cervices is a little easier to navigate now that six pounds of baby has gone through it, but I don’t care to test that theory for no good reason. A tiny part of me is holding out hope that Valium plus baby plus lack of septum (and therefore more space for the hand that rocks the speculum) might mean no tenaculum, even. A girl can dream.

Item: I mentioned this to the nurse who took my blood on Tuesday (progesterone check), and she asked if my inseminations had always been difficult. They were, I said, but less bad with the Valium. I think the first one, with no Valium, was traumatic for everyone, not just me, and for me it was downright ghastly. (To say nothing of the pressure I felt to think warm, welcoming thoughts for a baby, while I was getting stabbed and prodded to the point of tears.) Yes, she said, I think I was there.

And you know what, I feel downright comforted to know that she remembers. The Baby Factory is a big place, with a lot of patients, and this was some time ago. I just looked back at the post I wrote at the time, which in no way captures the horror — no doubt I was imagining some future baby reading about his beginnings and didn’t want to scare the mite (guess who hasn’t filled in the birth story page of her son’s baby book?). We don’t need to go back over such old wounds as that, but suffice it to say that directed coughing in no way distracts from the pain of having yet another cervix stabbed with pointed tongs yet another time, and that seeing the doctor break a sweat isn’t very calming. No one said anything much about it at the time — and what could they have said that would have done anything but worry me? — but I am relieved to know that my impression of the day wasn’t crazy.

Item: That the transfer is on Friday means a doctor I haven’t met before (I think. Unless she was at the aforementioned IUI of nightmares.) will be on duty. And thank heavens for that. Had it been Thursday, we could have had the same guy who did the Bean’s ET, which has a cute aspect to it and all, but also has the less winning quality of requiring me to spend more time pants-less with a paternalistic asshole.

Seriously, I don’t know what this guy’s deal is, but it certainly could use a slightly more robust idea of his patients’ bodily autonomy. I found myself in stirrups with him again last week. He looked at my chart and said, in a disbelieving tone, “natural FET cycle? Why would you do that?”

You know that thing when some guy asks you some supposedly neutral question, like what your name is or why you look a certain way (usually: not thrilled just to be near him), and you just know that no matter what you say, you’re about to get hit on/told you are misbehaving/both? (And okay, I’m sure there are instances of women doing this, but stick with me here.) And you seem, in that moment, to have a choice about how to respond — to take the question at face value or to address its obvious subtext by ignoring him/ rolling your eyes/ telling him off — but really, there is no choice, because either you are going to walk right into the condescension (by being nice), in which case you aren’t allowed to complain about it, or you are going to socially overreact, which means you get called a bitch? Anyway, Dr. Paternalistic (who shares a name with a city in California, if you are local and curious) is like that. There’s no right answer. Except instead of his being a stranger on the street, he is the only one in the room wearing pants, and he’s holding an ultrasonic baton.

Gamely, I said, “why not?” And really, why not? My actual doctor thinks my odds of success are the same this way as in a more medicated cycle. But he didn’t like that answer, because this kind of cycle means I have to come into the office a lot, which, by the way, I haven’t indicated any impatience with, because I don’t actually mind. So I said that I liked that this cycle meant I could avoid the progesterone shots (since my body will make its own, meaning the suppositories are sufficient insurance). This isn’t an insignificant reason, to my mind — a few extra office visits versus stabbing myself in the increasingly lumpy ass for three months? No contest — but he looked unconvinced. “Also,” I said, bracing myself, “I liked the idea of letting my body do its own thing, since there’s no indication of any problem with my hormones.”

“I GUESS,” he replied, with all the self-effacing deference I’d expect from a fourteen year old. And then he stuck a dildocam in my vagina. Because that’s how this game goes. At least there’s no septum for him to make me feel bad about anymore.

Item: I cried on the bus ride to school after that. I’m sure it’s frustrating, as a doctor, when patients don’t make the same decisions you would — hell, I’m frustrated by other people’s decisions all the time — but maybe make a distinction between decisions that actually have anything to do with health outcomes and those that don’t. And then maybe try not to be a jackass, also.

Item: On the other hand, the nurse who gave me my trigger shots (two, because they are subcutaneous now and therefore weaker) on Saturday is in my good books. She, too, noticed and commented on the NATURAL scrawled on my chart. They don’t do many cycles this way, and that note has a lot of highlighter on it. “Good for you! Making your own follicle!” And then she stabbed me in the stomach (because that’s how this game works) and we talked about people eating their placentas. Not our thing, we agreed, but no reason others can’t do it. Imagine that.

Item: For the medical record, the progesterone is different this time. Last time, it was little waxy bullets from a compounding pharmacy, but this time I was given a choice between Crinone twice a day or prometrium thrice. My decisions was entirely based on math: 2<3. So far, the crinone is fine, except for making me crampy and leaving an absolutely revolting substance behind for removal during shower-time spelunking. Still, I will take gross over painful any day of the week.

Item: For the further medical record, following an awful morning of intense nausea, I decided to be pushy and ask if I really needed the doxycycline I'm on, given that I've had no invasive egg retrieval this time, no one thought I needed prophylactic antibiotics for an IUI (which is not essentially different from an embryo transfer), and my stomach is still all ducks and drakes from this sinus adventure. Message relayed via nurse is that I can indeed stop it, and I think I shall. I shall carry on with the methylprednisolone (how much extra do you think my insurance paid for the pre-metabolized version of a cheap, old drug?), as I can see the medical point of that one.

Message goes on to say that I must also stop taking Prilosec and Pepcid post-transfer, which is less good news. (Sinus doctor wants me to stay on both for another month while things heal; they a not presently back to normal.). I remember from last go-round that Dr. BF didn't even want me taking lysine for cold sores while under his wing, so this is hardly surprising. Lysine is an amino acid, for crying out loud; it's in FOOD. Similarly, I was directed to take both Pepcid and Prilosec while pregnant with the Bean, though admittedly later in the process. I guess every drug is suspect except the fertility drugs, which we all know wouldn't hurt a fly. I am at heart a Good Girl, though, so I will try for a bit and cry to my new OB if things get hairy.

Item: I can't believe the Bean is still asleep, but I woke him up prematurely yesterday (following his passing out on the floor in the late afternoon, following heroic meltdown, following utter refusal to nap earlier) and he still didn't go to sleep in a timely manner last night.

Item: Acid reflux and moral purity be damned, Sugar and I are going out for what I hope is a last-gasp cocktail tonight. Which means the Bean will have a babysitter, and sleep, well, that's her problem.

One of the hardest things for me to learn in college, which was my first extended period away from a household headed by two doctors, was that when people say, I’d rather not talk about that at the dinner table, they may actually mean it. It took a few years (sorry, everyone), but eventually I learned, more by rote than by true understanding, that many people not raised by wolves scientists actually do feel physically bothered by descriptions of vomit, mucus, and thick, green eyeball-pus.

With that in mind, I’m at something of a loss to describe the past several weeks of life at Casa Biónica. I profoundly hope we are getting better. It remains to be seen.

By we, I mostly mean me. Sugar and the Bean are fine, following their own revolting but brief illnesses. I am on round two of antibiotics and now oral steroids for this sinus infection, which I just don’t know how to talk about without sounding like I am being over-dramatic even by my own standards. It’s just…I’ve been really, really sick, y’all. Like, sick enough that I am 95% sure my teaching evaluations will be bad this semester, because I can’t think and half the time I can breathe or consistently talk, either. Sick enough that Sugar has been sleeping with the Bean, and you know how she feels about cosleeping. Sick enough that I don’t even want to eat ice cream.

I have had a number of go-rounds with my ordinarily great internist, in which I tried to explain that things were Not Right and she worked to convince me that I was having allergies and asthma and would clear out the sinus stuff with just some steroid nasal spray and patience. I have also learned that it is possible to vomit just from nasal spray, if you are pushed hard enough. Also that sinus infections can come out of your tear ducts and give you proper conjunctivitis, and by the way, eye drops can make you puke, too.

Finally, she suggested I see an ENT, who took a horrified look (and some very unpleasant pokes) around the wreck of my head, started using words like “really dangerous” and “worried about you,” and gave me his cell phone number with repeated instructions to call him this weekend if I felt even a little worse despite prednisone and new antibiotics (augmentin…what to get for the woman who has everything, says a chemist friend). I am seeing him again on Tuesday, at which point I gather he may have some results on the cultures he skewered out of me and will adjust the meds if necessary.

Because of the prednisone, he gave me strict instructions to stop taking NSAIDs, which is bad news given the expectant-Zeus style headaches I’ve been having, and not to drink any alcohol, which has not done much for my mood. Also because of the prednisone, I am having the most horrific depression, alternating with fiery rages and the kind of anxiety that feels like your blood has been carbonated. I am tapering now and more hopeful that I will get through this without a homicide conviction, but I’d still recommend keeping your distance, especially if you are one of the people I’ve run into who seem to think all I need is to give up dairy and pour salt water up my nose. (For the record: the infection is now lodged in, among other places, my frontal sinuses, well beyond the reach of snot-potting, and plenty of bacteria are the kind of paleo enthusiasts that don’t miss milk one bit, given a nice, warm chalet snuggled up against a tender brain.)

I’m finally improving enough to write this, though, and I just thought I should let you know that the hysteroscopy didn’t kill me or anything. It was not great and not horrible — a bigger deal than i had imagined, but the whole alien-civilization-in-my-head business has dulled much of the memory of it. (Which would be handy if it hadn’t also wiped clean my short and long term memories, in general.) I have a follow-up with Dr. BF on Wednesday, which I hope will include being cleared for take-off for a May FET. Assuming, that is, I can rid myself of this scourge and the crippling existential angst that apparently accompanies infections for me (ah, my youthful dalliance with giardia!), waking me at five in the morning in a dead panic that I can’t possible handle being pregnant/giving birth/having another baby. Happy spring!

You might be a trifle done in, if your foremost thought at the prospect of upcoming surgery is relief at the idea of spending a few hours knocked out.

Returned to the Baby Factory this last week, for another look at my storied uterus. During the last dildo-camming, all appeared normal, but the spotting I’ve been having for up to a week before my period for the past several months made Dr. Baby Factory suspect a polyp, one he might not have been able to see at that point in my cycle, when my lining is pretty plush. Sure enough, at the low-nap of CD 8, there it was, big as life and smack in the middle of everything. Even I could have diagnosed something from that ultrasound, though I might have gone with “spontaneous mini-kidney.”

It’s not huge, as these things go, 7 by 8 millimeters or so. Dr. BF says lots of people get pregnant with polyps. But lots of people have miscarriages with polyps, too, and after watching a youtube video of one getting excised, I think understand why: the sucker didn’t bleed. If there’s one thing I know for sure about uterine tissue, it’s that it ought to be robustly vasculated, embryos not being entirely unlike vampires in their basic desires.

So. Out it comes, via hysteroscopy. That’s hyster- for “uterus” and -scopy for “you’d rather not be awake for this.” Dr. BF only operates on Thursdays, my busiest teaching day this semester. Luckily, he is willing to do this surgery any time I’m not bleeding (some people only do them early in the cycle), which means I ought to just squeak in during spring break, a few days before I expect my period. That gives the ol’ ute April to recover herself for a May FET cycle. Here’s hoping.

If you’ve read, um, anything I’ve ever written here, you know what comes next is the part about how freaked out and anxious I am about all this. And believe me, I’d be telling you aaaalllll about it, except that, well, I’m not. Isn’t that weird? I don’t know who I am anymore, either.

Partly, this is because it will be Dr. BF wielding the scalpel cervix telescope/floodlight/scissors thing. I’ve been peeved at him once or twice (twice) during our time together, but he’s never given me the slightest reason not to trust him. Granted, I am not deaf to flattery, and he did call my ovaries beautiful and remark that he loves my (medically rarer-than-rare) uterus. But it’s more that the initial impression I got when first reading his blog (what? You don’t choose your doctors via blog? Wish Dr. Russian had had one), that here was someone with a careful mind who also really cared about his patients, seems to have been accurate. I was a little surprised, during our Triumphal Return appointment, that he didn’t ask much after the Bean. It occurred to me later, however, that there is something really refreshing about talking to someone who seems mostly interested in me, not just the fruit of my wacky womb.

My mother has a story along these lines, which I’m going to put in here because it is funny and my paragraphing is all to hell anyway. Ahem. Mama went to medical school with a woman who had an identical twin living in the same area. Her twin gave birth, attended by a doctor the med students knew. When she saw him next, the med student thanked him for delivering the baby. He looked blank. Incredulous, she asked, “don’t you ever look at their faces?”

I trust Dr. BF because of the post that led me to him, in which he discussed common mistakes in diagnosing mullerian anomalies, because knowing how to do something wrong is an important part of truly understanding how to do it right. I trust him because I know he cares about his patients, not just because he has been considerate of our feelings (mostly — still holding a grudge over that psych consult), but because his blog was the first (only) place I’ve heard a doctor express disdain for the term “chemical” pregnancy, on the grounds that it diminishes the experience of loss. (That I read this right after Dr. “I’m sure you don’t have a septum even though I’ve never examined you” seemed cozily baffled by my observation that “incompetent cervix” is an obnoxious term makes the memory stand out.) And I trust him because I watched his video of a hysteroscopic resection of a uterine septum, which I heartily recommend if that kind of thing doesn’t squick you out.

I admit that I am pretty sad that this means no travel during break. I had visions of a jaunt up to friends in Boston or down to Starr Hill, but Sugar can’t travel the first weekend, and even though I know recovery from this sort of thing is supposed to be no big deal, the thought of counting on feeling up to schlepping somewhere the following day with a toddler in tow makes me queasy. It’s just, I’m lonely. I hadn’t counted on how isolating this “having a toddler means someone is always sick” business would be, and lately, someone is always sick. (And holy smokes, this latest one is a doozy. It’s taken a week to write this, and it hasn’t been a fun week.) I miss seeing friends, you know, in the ol’ Real World. Guess I should have thought of that before I went and got myself knocked up. Meanwhile, I don’t know what I’d do without y’all, I really don’t.

Speaking of, did you know you’d almost gotten me to not care about the specter of those PIO shots? Only almost, but almost is a big deal in this context. You are a pretty amazing bunch. Drinks, all around.

Which brings me to the appointment’s good news. I admit it, after the PIO surprise, I played the field, support-wise. I will always love y’all best, you know that. But I also asked about it on a forum, and one of the women there asked why I wasn’t doing a “natural”* FET. Was there any reason to believe my previous difficulties were related to my hormone levels?

*someday you will get my rant on how much I hate that word. It’s long.

Well, now that you mention it, no, there isn’t. We’ll never know for sure, but I favor Dr. BF’s hunch that I wasn’t getting pregnant via IUI because of structural issues: the endometriomas were preventing eggs from leaving my ovaries, various adhesions were keeping the Fallopian tubes from picking them up, scarring in the tubes was generally fouling things up, or some combination. Given how very many eggs I made on a moderate FSH dose (32), how much those eggs seemed to like the sperm in question (24 fertilized), and how happily the resulting embryos grew (12 frozen, one currently staring in adoration at the engines of Sodor), these explanations seem quite plausible.

Indeed, I had always imagined we would do an unmedicated FET, but when that’s not what Dr. BF described at our recent consult, I just assumed there was some reason. Insert the usual business of not wanting to look foolish by asking. Yes, it’s a great defense mechanism, why?

Emboldened by my forum friend, this time I did ask Dr. BF what he thought…and it turns out he thinks it’s fine! He might still want me to do some progesterone supplementation, but the good old coochie bullets are fine for that. I asked him about odds, expecting they would be lower than in a medicated cycle, but he said that assuming they don’t miss my ovulation (which would mean game over that cycle — this is why they don’t do many cycles this way), he thinks the odds are about the same.

I feel great about this idea, and not only because it limits the ass-stabbery to one trigger shot. I feel excited at the idea of giving my body a chance to just do its thing — at least, as much as such a thing is possible after embryologists have entered the picture. It makes me a bit warm and fuzzy, it turns out, to imagine trusting my body.

The appointment went well. Dr. Baby Factory did not, after all, yell at me, you will be relieved to hear, though as always, he had that sad look that Sugar reminds me is mostly just how his eyebrows are shaped. His hair’s gotten a bit shaggy, as if the four years since we’ve met (is that all?) have taken him from being the 11-year-old star of the piano recital (as I always thought of him after seeing the picture in his office of him sitting ramrod straight up on one of the Today Show’s couches) to a 15-year-old with a garage band and a penchant for eschaton.

Dr. BF is who first suggested I go to Dr. Russian’s practice for OB, although in fairness he specifically recommended Dr. Robot, who left the practice in my first trimester. Nevertheless, I decided I would tell him to rethink recommending them, if not for Dr. Russian’s appalling manner (which I know you all believe me about, but which could sound like the whining of a delicate flower) then for the way Dr. Skinny, the head of the practice, dismissed out of hand my was-that-an-abruption bleeding in the days before labor. It is with deep pleasure that I report to you that he already has a call into Dr. Skinny, because he keeps having her patients come to him, get pregnant, and then refuse to return to her practice. (Smart women!) So I guess it’s not just me.

While we’re on the subject of Dr. BF, can I just say what an absolute artist that man is at a pelvic exam? Seriously, he is the only person ever whose haven’t hurt; even his double pap smears don’t hurt. (Yes, I am a special snowflake and regularly cry over medical messing about in my lady business(es). My cervices are on the inside for a reason.) I have to say that here because, 1) it is worthy of praise, and 2) there is no non-creepy way to express this sentiment in the moment.

So, the various bottom lines:

I will be making a lot more “bottom” jokes around here in the coming months. Enjoy.

My CD 2 numbers are, I think without digging for my old notebook of data, the best they have ever been. (FSH 5.6, E2 a shockingly low-for-me 39.)

My famous endometriomas (aka, “chocolate cycts,” if you are into ruining your ability to enjoy chocolate forever, which I am not) have apparently disappeared (?) (!). Is this even possible? I have noticed less back pain in the past few months, but I certainly felt plenty in cycles since being pregnant. I am befuddled. I’ll work on being glad, but right now I’m too confused. At any rate, the dildo-camming didn’t give me the usual sensation that a smoldering rat is trying to scramble out of my lower back, which was a nice change.

We have lots of embryos, and Dr. BF seems optimistic about our chances, or as optimistic as his eyebrows will allow.

Scheduling is a bit of a annoyance, more so than I had anticipated. I have the good insurance for six months, March-August. I naively assumed this meant time for several cycles, but I had forgotten that the Baby Factory closes for IVF and like matters three months of the year, and two of those months are April and August. When the scheduler explained that an April cycle, which was what I had begun to imagine, wasn’t going to happen, I felt bathed in adrenaline. March? March?!? That’s so soon! But waiting doesn’t make a lot of sense, under the circumstances, so March it is. Then I drank the warm apple juice she’d brought when I got woozy missing the half-gallon of blood they’d siphoned off for still more tests. When a few molecules of sugar reached my brain, I remembered that I can’t do March, because Dr. BF wants me to come back early next cycle to see if a polyp is what’s making me spot so much before my period or if it’s just my good buddy endometriosis.

So May it is. I am not entirely sorry to wait, though I had gotten myself slightly excited about Just Doing It. I am worried that between the possible polyp and the closures, my six months of insurance just became three (and that’s assuming there’s no polyp or that it can come out quick-like in April). However, billing had a surprise for us: the less-good insurance (under whose begrudging, code-careful auspices we had this consult) actually covers quite a bit more than we had thought. Doing a cycle with them would still be more expensive than with the good insurance, but it sounds at the moment like it wouldn’t be impossible, especially if we planned ahead and got the drugs while I’m still on the good plan.

May gives me time for a few more visits to the favorite cocktail bar I am just now falling back in love with. It also gives me some time to get worked up about various parts of this whole gig I wasn’t expecting.

For instance: more shots. When I was first contemplating IVF, I decided I could deal with the little needles for stims but not the big ones for progesterone-in-oil, and Dr. BF agreed that I could use coochie bullets — excuse me, vaginal suppositories; excuse me, non-American readers, pessaries — instead. They were messy and sort of annoying, but I was never sorry to be missing the intra-muscular missile to the butt I’d read about on other blogs, still less the bruises and lumps and lingering scar tissue. But I guess now I get to learn for myself what all the fuss is about, because Dr. BF says (and, I regret to say, that the study I found on the topic agrees) that the delivery method really does make a difference in FET cycles. Dr. BF says that during my IVF cycle, I was making some progesterone on my own, but that during a medicated FET, I won’t, which means that small differences in efficacy can mean big differences in results.

So one thing I guess I could use about now is some PIO pep-talking, should you have any on hand. I’m not upset by needles per se, but I am no great fan of personal pain, especially deliberately inflicted, in my own home, every day for three months. Call me crazy. However, I also realize that a miscarriage I would always fear I could have prevented is worse. Great choices, these are.

Okay, I know there are worse choices, I KNOW. I know that, as subfertile lesbians go, I am sitting very pretty, what with the good clinic and the good insurance and the bewildering array of embryos. It’s just…I had forgotten what this part, when fear and uncertainty loom so very large, feels like. Frankly, I thought I got to skip it this time.

Mel asked the other day, after my first return to the Baby Factory for CD 2 blood work, whether I found that some of being back was much easier and some was ten times harder. Yes. That is exactly how I found it. At first, I was giddy, almost, being back in such a powerful place without the dread and exhaustion I remember from the last time around. This is a cinch, I thought, walking right up to the check-in computer to type my name. The first time I came in, I stood awkwardly in front of the receptionist’s desk for some time before a woman in a pompadour, whom I did not yet know was nosy as the day is long and none too quick on the uptake, informed me in one of those New York lady klaxon voices that still startle me that I was doing everything wrong, as though it weren’t understandable that a person might imagine their office worked like every other office on Earth. This time, the receptionists were new and muscle memory guided my hands through the menus as surely as if they were ticket machines at Grand Central. Bam! I thought, jabbing the CD2 bloodwork button, my doctor’s name, my insurance carrier. I got this. I even made a self-deprecating joke about sperm to the guy ahead of me in line. (Sorry, sir. I should probably not be allowed in public alone, at least not while giddy.)

As I waited for my name to be called, a strange nausea crept over me. I hadn’t, I realized, been comparing my present-day self with the me who had first come to the Baby Factory at all; I’d been comparing myself to my memory of that person, a memory colored by knowing that my first visit was only the beginning, that there were miles to go, disappointments and fears and more than a few crying jags. In fact, that very first me, the one the receptionist startled, was a lot like this me: happy, excited, hopeful. I had mainly wanted to go to an RE because of my mysterious lady-part arrangement and because my insurance covered it and the Gyn I’d gone to was a dick, so why not? I imagined we’d leave with a plan, buy some sperm for home use, and have a baby in less than a year. Although our story ended happily, that original me sure had another think coming.

The PIO surprise was like a bucket of cold water to the face in part because I thought this time was going to be so easy. Aren’t FETs supposed to be so simple compared to a fresh cycle? I suppose it is simpler, in that I don’t have to come to the office much and won’t get OHSS this time, but I had forgotten that simpler isn’t the same as easy. I know what to expect from an IVF cycle, but an FET is nevertheless new to me, bringing with it all the anxiety that attends medical novelty. That I know how to get to the clinic and where to buy a coke after they exsanguinate me for science does not mean I know anything about what’s going to happen, and worse, it doesn’t mean I have any control over the results. I know I’m a lucky subfertile lesbian, but dammit, why can’t I just be a fertile one? I thought skipping the rounds of IUI this time would make me feel fertile, but that fantasy is crumbling now that I remember that this “fertility” still involves doctors and needles and tenacula and fear. I never really believed this when we were trying to conceive the first time, but it turns out this secondary infertility jazz is, to paraphrase Smarshy’s memorable image, just a different bag of ass.

The reason I am a staticky ball of anxiety — like, if you turned off the light, I’m sure you could see little lightning flashes around me — isn’t that I am having cold feet about returning to the Baby Factory, per se.

I realized talking to Sugar just now that the reason I wasn’t worried about my bloodwork visit the other day but I am scared to see Dr. Baby Factory himself is that I have in my mind that he will somehow yell at me about something. What he’d have to yell at me about, I don’t know, but then, I wouldn’t have thought there was a lot it made sense to ream out a limping, anemic mother of a six-week-old for, either.

In my actual brain, I know that Dr. BF is a kind, gentle man who will may even be happy to see us and want to see a picture or two of the Bean, seeing as how he was rather small last time they were in a room together. We’ll see if I can get my viciously tense body to listen to reason, but at least my brain feels better.